A person can go to jail for a HIPAA violation when the conduct is a knowing and unlawful obtaining, using, or disclosing of individually identifiable health information, and the case is pursued as a criminal matter by the U.S. Department of Justice rather than treated as a civil compliance enforcement action by the Office for Civil Rights.
Most HIPAA violations are handled as civil matters involving covered entities and business associates, with outcomes that can include investigations, corrective action plans, monitoring, and civil monetary penalties. Civil enforcement focuses on whether the organization complied with the HIPAA Privacy Rule, HIPAA Security Rule, and HIPAA Breach Notification Rule requirements, including policies and procedures, workforce training, risk analysis and risk management for electronic protected health information, access controls, and breach response processes.
Criminal liability applies to individuals and depends on intent. The federal criminal statute covers knowing conduct involving a unique health identifier or individually identifiable health information maintained by a covered entity when the individual obtains or discloses the information without authorization. The penalty levels in the statute allow a fine up to $50,000 and imprisonment up to one year for the base offense, a fine up to $100,000 and imprisonment up to five years when the offense is committed under false pretenses, and a fine up to $250,000 and imprisonment up to 10 years when the offense is committed with intent to sell, transfer, or use the information for commercial advantage, personal gain, or malicious harm.
Workforce behavior that commonly creates criminal exposure includes accessing a patient record without a job-related purpose, disclosing patient information to an unauthorized person, obtaining patient information for personal use, and using patient information for financial benefit. Jail sentences are not automatic for every improper access or disclosure, and the facts that support knowing conduct and intent determine whether a criminal case is pursued and what charges are filed.
Organizations remain subject to civil enforcement even when an incident involves employee misconduct. Covered entities and business associates are expected to apply workforce sanctions consistent with written policies, implement role-based access and audit controls, restrict access to protected health information to the HIPAA Minimum Necessary Rule standard for permitted uses and disclosures, and document investigations, mitigation steps, and breach notification decisions when unsecured protected health information is involved.